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Pandemic paradigm: Baltimore County mental health therapists, clients adapt to new dynamic

Kiara Hartwell, runs a one-person counseling service in Catonsville, KJ Hartwell, LLC. She said that early in the pandemic some clients were hesitant about virtual therapy sessions, but the reluctance wore off.
Kiara Hartwell, runs a one-person counseling service in Catonsville, KJ Hartwell, LLC. She said that early in the pandemic some clients were hesitant about virtual therapy sessions, but the reluctance wore off. (Jeffrey F. Bill/Baltimore Sun Media)

For all the wrong reasons, local mental health practitioners are seeing a substantial uptick in the number of people seeking help for anxiety, depression and other issues burdening them.

The major reason, not surprisingly, is the COVID-19 pandemic that is responsible for what President Joe Biden calls a “very dark winter.”

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Other problems, such as social unrest, a racial reckoning and a generally contentious political climate culminating in the insurrection at the U.S. Capitol by supporters of then-President Donald Trump on Jan. 6, only add to the stresses of American life in 2021.

“Everything that was there before is still there [with regard to people’s level of stress],” said Mark Donovan, the chief operating officer of Columbia-based Congruent Counseling Services, a practice that boasts six locations, including one on York Road in Towson. “And now there’s COVID-19 and politics to add to everyone’s stress level. No matter what side of the fence you’re on, there’s just more stress.”

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The pressure cuts both ways.

With more people seeking solutions for their mental health problems, professional therapists are inundated with requests for services that can only be provided these days through remote counseling sessions, also known as tele-therapy. That method of therapy can be less than ideal for both the patient and the health provider, although it is probably here to stay — at least until the pandemic subsides.

Donovan said that he first floated the idea of tele-therapy to his counselors in what now seems like the long-ago pre-pandemic era.

“Last January, I asked them if they wanted to work from home; they all said ‘no’” he said.

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More than 10 months into the new normal, Donovan said he now knows why his 40 full- and part-time employees preferred in-person sessions.

“It’s been pretty tough on my staff,” Donovan said. “They’re getting burned out. But we are working with all our counselors to take breaks and stay healthy.”

Donovan, who sees clients as well as runs the practice, has similar concerns of his own about not having in-person involvement, he said.

“I don’t like it as much,” he said. “It doesn’t have the same feel. And I miss things like seeing body language, getting energy [from the session] and feeling a connection [to the client]. Even though we’re getting better at it, it’s more stressful for the clinicians.

“I used to be able to see eight to 10 clients a day. But I can’t do that remotely. It’s more draining, and I miss having the other clinicians around to bounce things off of.”

Kiara Hartwell, a therapist whose practice is on Rolling Road in Catonsville, said that for patients with social anxiety, for instance, tele-therapy is a mixed bag.

“Though it works better for them,” she said, “[tele-therapy] is not able to fully address the issue of social anxiety, where coming to the office would help them navigate the goal of being more comfortable in social situations.”

Towson Mental Health owner Eve Del Monte, whose practice includes many younger children, teens and young adults, said that it can be more difficult to work remotely with certain patient populations, including younger children and those diagnosed with autism spectrum disorder.

“It can make it very difficult,” Del Monte said, noting that clinicians at her practice opt to see approximately 20% of their clients in person.

With a new air filtration system installed and strict mask-wearing protocols in place at her Falls Road practice, she said in-person sessions are becoming more typical.

Moreover, Del Monte and her staff already have received one dose of the vaccine, which should help to alleviate fears of contracting the virus in her offices. (Medical experts still don’t know how transmissible the virus is from people who have been vaccinated, but recommend that they continue with precautions such as mask wearing and social distancing.)

“I personally would rather see my clients in person,” Del Monte said. “I don’t particularly like staring at a screen for eight hours a day. I miss the energy you get from being in the same room together.

“When we are in person my clients aren’t worrying that their brother or sister is listening outside the door. And sometimes there can be disruptions to internet service.”

On the other hand, dealing with technology is usually less clunky for her younger clients.

“Teens are very used to communicating that way,” Del Monte said. “They’re very resilient. They just kind of roll with it.”

Young adults are often just as comfortable as teens in that regard, considering that both groups have grown up using technology.

At least that’s the case for a 25-year-old inventory analyst who said that one overlooked aspect of tele-therapy is that the connection between counselor and client doesn’t have to change if the client moves from one city to another.

One such client, who requested anonymity, said that keeping in touch with the same counselor has been key during her long battle with depression, ADHD and trauma from being homeless six years ago.

“It would have been difficult for me if I wouldn’t have been able to keep her,” said the client, who moved to Towson in September. “So, I’m grateful for that. She’s always been there for me, she’s easy to talk to and she understands me very well.”

On the other hand, the client, who takes medication for ADHD, said that the lack of a structured environment while working from home makes it easier to miss therapy sessions.

“I just don’t pay attention,” the client said. “I have trouble keeping up with what time it is.”

Even so, the continuity in the Towson client’s relationship with a counselor has meant that weekly therapy sessions are no longer needed.

Counselor and client will now Zoom every other week instead, a breakthrough in their two-year therapy journey together.

The pandemic has necessitated adjustments all around. For Congruent Counseling Services, it meant dealing with a significant decrease in the number of clients during the lockdown last spring, in the early days of the pandemic, according to Donovan.

“It dropped considerably at first,” he said, noting that 98% of his clients returned by the summer before the remaining 2% returned.

Since then, he and his counselors have been so busy that they’ve had to turn away new clients.

Part of the reason is that while the demand for counselors is high, the supply is low.

Because becoming a counselor requires a master’s degree, and securing state certification takes three or four more months, finding suitable employees to meet the burgeoning demand has been difficult.

“The number of people calling [for counseling] has been through the roof the last six to eight months. We are very busy,” said Donovan about Congruent Counseling and its locations in Baltimore, Howard, Anne Arundel and Montgomery counties. “We’re doing well, but some smaller practices just can’t find enough clinicians.”

Hartwell said some clients were hesitant about virtual therapy sessions at first, but the reluctance didn’t last long.

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“Some people were on hold for a while,” she said. “But others didn’t seem to have that hard of a time by going virtual. In some ways, I think they prefer it, because it cut down on travel time getting to my office. For me, it hasn’t been that much of an issue.”

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Working solo, Hartwell, who said her “niche is working with millennial and Gen Z [1995-2010 birth years] adult women struggling with anxiety, depression and life adjustments,” does not have to worry about hiring a staff.

She said that what she does deal with is how minorities, especially from Black communities, have been deeply affected by the pandemic, social unrest and continuing systemic racism.

“A lot of my clients are people of color,” added Hartwell, who is Black. “It’s been a very trying year for them. A lot of it is just about not knowing what’s next.”

Del Monte and her colleagues all have to confront the volatile nature of schooling in the pandemic-era, especially for students already combating anxiety and depression.

“It’s a different way they have to attend school now,” she said, alluding to hybrid schedules that can be disrupted by outbreaks of the virus. “It’s like whiplash. One week they go to school two days a week, and the next week they might be off after somebody contracts COVID. Rules and schedules are changing constantly. For students with high anxiety, they don’t get the consistency that they need.”

Del Monte added that she and her staff traditionally work with schools in a “consistent and measured way to implement techniques and strategies” for her patients.

In a pandemic world, though, everything takes more of an effort.

“What used to take a month may take five months now” to get the same results, she said. “We just have to be a little more creative today.”

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